急性颈脊髓损伤患者肺部感染的危险因素及病原菌分析

Risk factors and pathogen analysis of pulmonary infection in acute cervical spinal cord injury

中文关键词:  急性颈脊髓损伤  肺部感染  病原菌  耐药菌

英文关键词:Acute cervical spinal cord injury  Pulmonary infection  Pathogens  Drug-resistant bacteria

中文摘要:

  【摘要】 目的：探讨急性颈脊髓损伤患者肺部感染的危险因素与病原菌分布特点及耐药性。方法：2010年1月~2014年12月收治急性颈脊髓损伤患者527例，发生肺部感染83例，应用Logistic回归方法分析肺部感染与颈脊髓损伤部位（C1~C4为高位损伤，C5~C7为低位损伤）、ASIA分级、气管切开及机械通气的相关性，并分析肺部感染患者痰细菌培养的细菌种类、株数及耐药率。结果：ASIA分级A级患者158例（30.0%），其中高位损伤43例（8.2%），均行气管切开、呼吸机辅助呼吸，发生肺部感染39例（90.7%）；低位损伤115例（21.8%），52例行气管切开，21例行呼吸机辅助呼吸患者中肺部感染16例（76.2%），31例未行呼吸机辅助呼吸患者中肺部感染7例（22.6%）。B级103例（19.5%），其中高位损伤27例（5.1%），19例气管切开、呼吸机辅助呼吸，肺部感染12例（63.2%）；低位损伤76例（14.4%），27例气管切开，18例呼吸机辅助呼吸患者中肺部感染2例（11.1%），9例未行呼吸机辅助呼吸患者未发生肺部感染。C级83例、D级183例，均未行气管切开及呼吸机辅助呼吸，均未发生肺部感染。Logistic回归分析显示高位颈髓损伤、ASIA A级损伤及机械通气均是急性颈脊髓损伤患者肺部感染发生的危险因素（P≤0.001），气管切开对肺部感染的发生率无显著性影响（P=0.07）。83例肺部感染患者痰标本培养出细菌117株，其中多重耐药菌75株（64.1%）；其中非发酵G-菌（铜绿假单胞菌、洛菲不动杆菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、臭鼻克雷伯菌、液化沙雷菌、苯丙酮酸莫拉菌、产碱假单胞菌）76株（65.0%），其中59株（77.6%）多重耐药；金黄色葡萄球菌23株（13.8%），其中耐甲氧西林金黄色葡萄球菌（MRSA）7株（30.4%）；肠杆菌（产气肠杆菌、阴沟肠杆菌）12株（10.3%），其中5株（41.7%）多重耐药。结论：高位、完全性颈髓损伤及机械通气是急性颈脊髓损伤患者肺部感染发生的相关危险因素，肺部感染的病原菌主要是多重耐药非发酵G-菌，MRSA及多重耐药肠杆菌亦占有一定比例。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors, pathogen distribution and drug resistance of pulmonary infection secondary to acute cervical spinal cord injury. Methods: From January 2010 to December 2014, 527 patients who suffered from acute cervical spinal cord injury, among them 83 cases complicated with pulmonary infection, were treated. The injury sites(high level: C1-C4; low level: C5-C7), ASIA grade, tracheotomy and mechanical ventilation to pulmonary infection were analyzed by Logistic regression. The sputum culture due to pulmonary infection, the bacterial species, number of isolates and resistance rates were also analyzed. Results: 158 cases(30.0%) were assessed as AISA grade A, among them 43 cases(8.2%) with high lev?鄄el injury received tracheotomy and mechanical ventilation, among them 39 cases(90.7%) suffered from pulmonary infection. Among 115 cases(21.8%) with low level injury, 52 cases received tracheotomy, and 21 cases received mechanical ventilation, among them, 16 case(76.2%) suffered from pulmonary infection, while among 31 cases without mechanical ventilation, 7 cases(22.6%) suffered from pulmonary infection. 103 cases(19.5%) were assessed as ASIA grade B, among 27 cases(5.1%) with high level injury, 19 cases received tracheotomy and mechanical ventilation, among them, 12 cases(63.2%) suffered from pulmonary infection. Among 76 cases(14.4%) with high level injury, 27 cases received tracheotomy, among 18 cases receiving mechanical ventilation, 2 cases(11.1%) suffered from pulmonary infection. No pulmonary infection was noted in 9 cases without mechanical ventilation. 83 cases and 183 cases were assessed as ASIA grade C and D, respectively, no tracheotomy, mechanical ventilation or pulmonary infection was noted. Logistic regression analysis showed that high level injury, ASIA grade A and mechanical ventilation were risk factors for pulmonary infection secondary to acute cervical spinal cord injury. No significant correlation was found between tracheotomy and pulmonary infection(P=0.07). 117 bacteria were cultured from the 83 cases suffering from pulmonary infection, among them, there were 76(65.0%) G-non-fermenting bacteria(P.Aeruginosa, Loffi Acinetobacter, Acinetobacter baumannii, Stenotrophomonas maltophilia, K.ozaenae, Serratia liquefaciens, Phenylketonuria Moraxella and Pseudomonas alcaligenes), in which 59(65.0%) were multi-drug resistant(MDR), 23(13.8%) were Staphylococcus aureus with 7(30.4%) MRSA, 12 were Enterobacter(10.3%) with 5(41.7%) MDR Enterobacter. Conclusions: High level injury, ASIA grade A injury and mechanical ventilation are risk factors for pulmonary infection secondary to acute cervical spinal cord injury, multi-drug resistant G-non-fermenting bacteria are the main pathogens of pulmonary infection, while MRSA and multi-drug resistant enterobacter consists a certain proportion.